Balancing risk/benefit of opioids for chronic non-cancer pain (CNCP) challenges primary care providers (PCPs). The Opioid Renewal Clinic (ORC), is a pharmacist-run program supporting PCPs' use of opioids to manage CNCP in patients with aberrant behavior or substance misuse/abuse risk. The investigators aimed to identify demographic and clinical predictors of resolution of aberrant behavior over one year.

Methods:

After IRB approval, investigators conducted a retrospective chart review of all196 subjects referred to the ORC from 9/1/02 to 7/15/04 for aberrant behavior (by positive urine drug screen (UDS) or a pattern of early refill requests), evaluating aberrant behavior outcome at one year. Univariate analysis of the association of the association of demographic and clinical variables with aberrant behavior was followed by logistic regression to identify independent predictors of outcome.

Results:

Of the 196 referred, 44 % (n= 86) resolved their aberrant behavior at one year. Other outcomes included: discharge by self or the ORC, for their inability to follow ORC agreement (n= 82, 41.8 %); refer for addiction (n=21,10.7 %); or weaning from opioids due to urines consistently negative for prescribed opioid (n=7,3.6 %). Logistic regression showed a history of cocaine dependence independently predicted poor outcome, increasing the odds of failure (aberrant behavior not resolved) by almost 4 times (OR=3.805, p=.006). Contrarily, each additional pain diagnosis reduced the odds of failure by about 14% (OR=0.861, p=0.02).

Conclusions:

Nearly half of the patients resolved their aberrant behavior within the ORC; but patients with cocaine dependence were at higher risk for failure, suggesting a need to develop tailored intervention for this subgroup. Aberrant behaviors tended to resolve in patients with multiple pains; possibly because their desire for relief, when reliably available, more strongly motivated behavior change. Further studies are needed.